Mandibular Fossa Approach to Petroclival and Anterior Pontine Lesions

Abstract

Objective To describe the anatomy related to a novel approach to the petroclival region through the mandibular fossa for the treatment of petroclival and anterior pontine lesions.

Design Five dry skulls were examined for surgical approach. Three adult cadaveric heads underwent bilateral dissection. One cadaveric head was evaluated with computed tomography after dissection.

Setting This study was performed in an academic medical center.

Participants Neurosurgical anatomy researchers performed this study using dry skulls and cadaveric heads.

Main Outcome Measurements This was a proof-of-concept anatomical study.

Results The mandibular fossa approach uses a vertical preauricular incision above the facial nerve branches. Removal of the temporomandibular joint exposes the mandibular fossa. The anterior boundary is the mandibular nerve at the foramen ovale, and the posterior boundary is the jugular foramen. The chorda tympani, eustachian tube, and tensor tympani muscle are sectioned. The carotid artery is transposed out of the petrous canal, and a petrosectomy is performed from Meckel's cave to the foramen magnum and anterior occipital condyle. Dural opening exposes the anterior pons, vertebrobasilar junction, bilateral vertebral arteries, and the ipsilateral anterior and posterior inferior cerebellar arteries. At completion, the temporomandibular joint is reconstructed with a prosthetic joint utilizing a second incision along the mandible.

Conclusions The mandibular fossa approach is a new trajectory to the petroclival region and the anterior pons. It combines the more anterior angle of endoscopic approaches along with the enhanced control of open approaches. Further study is necessary before this approach is used clinically.

Keywords

glenoid fossa - mandibular fossa - petrosectomy - petrous carotid - superficial temporal artery - temporomandibular joint

Note

The abstract was presented at the North American Skull Base Meeting; Phoenix, AZ; February 18–20, 2022 (abstract A113).

Publikationsverlauf

Eingereicht: 26. August 2022

Angenommen: 12. November 2022

Artikel online veröffentlicht:
03. Januar 2023

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